Health Insurance on DAFT: When You Must Switch, What Counts as “Insured,” and How to Avoid Fines

Last reviewed: January 2026

DAFT is DIY friendly. Dutch health insurance can also be boring and straightforward. The problem is that people delay, assume foreign coverage “counts,” or wait for perfect timing. When Dutch basic health insurance applies, it is compulsory and enforced. If you want calm, handle it early and keep proof.

This article is for DAFT entrepreneurs and their families, especially Americans arriving with U.S. insurance, travel insurance, or international expat coverage. You will get the rule, the timing, the enforcement reality, and a desk-friendly system to stay compliant.

If you are here because you received a CAK “uninsured” letter: don’t skim. Go straight to CAK letters and fines and I already have insurance, why am I uninsured?. A CAK letter is a timer.

Scope note: This is education and planning, not legal advice. Health insurance obligations have edge cases (cross-border employment, international organisations, posted workers, some student situations). If you think you are an exception, use the official SVB Wlz assessment process described below and keep the decision in your records.

Key official anchors: Compulsory standard health insurance (Government.nl), CAK uninsured letter guidance, SVB: Wlz vs Zvw, and Business.gov.nl: Zvw contribution for entrepreneurs.

The boring compliance plan in 8 steps

You do not need a perfect spreadsheet to do this correctly. You need clean dates, a Dutch basic policy (basisverzekering), and proof. Here is the simplest process that keeps you out of penalty territory.

Step 1: Anchor everything to your arrival date. Government.nl ties the obligation to arriving to live or work in the Netherlands. Use your arrival date as the date you build your admin around.

Step 2: Stop treating foreign insurance as “compliance.” Government.nl is explicit that you must take out Dutch health insurance even if you already have a medical insurance policy in another country. Foreign coverage may be useful as bridge coverage, but it does not remove the Dutch obligation when it applies.

Step 3: Push BRP and BSN forward immediately. Most “I’m stuck” stories are admin-chain problems. Fix the upstream pieces early so you can set up insurance, benefits, and the rest of your Dutch system without friction.

Related: BRP, BSN, DigiD: The Dutch Admin Chain That Unlocks Everything

Step 4: Take out Dutch basic insurance as soon as you can. If you take out insurance after 4 months, Government.nl states you will not be insured retroactively and you will not be reimbursed for care you received between arrival and the policy start date. Waiting does not buy free coverage. Waiting buys uninsured risk.

Government.nl: Late insurance (no retroactive reimbursement)

Step 5: Make the policy system-proof. Set up reliable payment, verify your BSN and address are correct in the insurer’s file, and store the confirmation PDF with the effective start date. Clean dates and clean admin prevent letters.

Step 6: If you receive a CAK uninsured letter, act that week. CAK states that if you haven’t requested a Wlz assessment or taken out basic insurance within three months after receiving their letter, you will be fined. The fine amount for 2026 is published on CAK’s site and indexed annually.

CAK: Received a letter that I’m uninsured (timeline, fine amount, RBVZ)

Step 7: Budget like a professional. You have a monthly premium. You may have costs that hit the mandatory excess (eigen risico). And as a self-employed person, you also pay an income-dependent Zvw contribution on business profits, assessed via the tax system. Do not let any of this surprise you.

Reference: Business.gov.nl: income-dependent Zvw contribution for entrepreneurs

Step 8: Keep a proof folder. Policy confirmation, first payments, and any CAK or SVB letters. If someone asks “Are you insured?”, your answer should be a PDF, not a story.

DAFT mindset: Don’t try to be clever. Be compliant. Early, boring compliance is the cheapest compliance.

This is not optional when it applies

In the Netherlands, the baseline is not a suggestion. Government.nl states that every person who lives or works in the Netherlands is legally obliged to take out standard health insurance. Additional health insurance is optional. Start from that reality.

Official: Government.nl: Compulsory standard health insurance

Business.gov.nl makes the entrepreneur angle explicit: anyone who lives or works in the Netherlands must take out healthcare insurance under the Healthcare Insurance Act (Zorgverzekeringswet, Zvw). This includes entrepreneurs and self-employed professionals. That is the category most DAFT people are in from day one.

Official: Business.gov.nl: Taking out compulsory healthcare insurance

Rule: If you are building a life and business in the Netherlands, assume Dutch basic health insurance applies unless you have a formal confirmation that it does not.

How this plays out on DAFT in real life

Most DAFT people don’t get stuck because they can’t understand insurance. They get stuck because the move is busy and the admin chain is unfamiliar.

A typical DAFT setup includes housing, BRP registration, BSN, DigiD, banking, KVK, and IND steps. Health insurance feels like one more task, so it slides. The system does not care why it slid. It only cares whether you are insured when the obligation applies.

Government.nl also warns that if you are registered with a municipality but have not taken out health insurance, you may receive a letter from the CAK. In other words, once your BRP registration is in place, your insurance status can get checked.

Official: Government.nl: CAK letter warning after municipal registration

DAFT takeaway: BRP registration is not the finish line. It is the starting gun. Once you are visible in the system, your insurance status becomes visible too.

What counts as “insured” and why Wlz and Zvw matter

Expats often use “insured” to mean “I have a policy that will pay.” The Dutch system is more structural. It is built around statutory schemes. That is why you keep seeing two acronyms: Wlz and Zvw.

SVB explains it in a way that matters operationally: everyone who lives or works in the Netherlands is insured under the Zvw scheme, and if you are insured under the Zvw scheme, you must have basic Dutch health insurance. This is the line that should stop the “I’ll handle it later” mindset.

Official: SVB: Difference between Wlz and Zvw

SVB also states that if you are insured under the Wlz scheme, you are also insured under the Zvw scheme. Everyone insured under Zvw is obliged to take out a basic insurance package (basisverzekering) with a Dutch health insurer. That is why, when the system says “uninsured,” it means “no Dutch basic policy on file,” not “you have no coverage anywhere on Earth.”

Official: SVB: If you have received a letter from the CAK

Plain English: Most DAFT entrepreneurs should assume Dutch basic health insurance applies. If you think your situation is an exception, prove it the Dutch way by requesting an SVB Wlz assessment.

Timing: 4 months, start date, and what happens if you delay

Government.nl removes the “when should I do this?” debate. If you come to live or work in the Netherlands, you need to take out Dutch health insurance as quickly as possible and no later than 4 months after arriving. Plan your setup around that window.

Official: Government.nl: 4-month timeline after arrival

Here is the practical DAFT version of this guidance.

Situation	What to do	Why it matters
You arrive and you are setting up a real life in NL	Assume Dutch basic insurance applies. Start arranging it immediately. Aim to be fully set up well before month 4.	The system is built for residents and workers. If you behave like a resident, comply like a resident.
You are waiting on BRP or BSN	Keep pushing the admin chain forward and start insurer conversations early. Keep written proof of what the insurer requires and what you have already completed.	Delay is how people drift past deadlines. Written proof protects you when timelines slip.
You delay beyond 4 months	Stop delaying and get insured now, but understand the tradeoff.	Government.nl states you will not be insured retroactively and you will not be reimbursed for care received between arrival and the policy start date.

People hear “not insured retroactively” and think it means “no back premiums, so it’s fine.” Government.nl also says you will not be reimbursed for care you received during that gap. That is the real cost of waiting. If you want lower risk, don’t create gaps.

DAFT priority: Keep your insurance dates clean the same way you keep your DAFT capital clean. Early compliance is boring. Late compliance is expensive.

Common confusion points (answered directly)

“I have U.S. insurance, so I’m fine.” Not as a rule. Government.nl explicitly states you must take out Dutch health insurance even if you already have a medical insurance policy in another country. U.S. insurance may still be useful as bridge coverage or supplemental coverage, but it does not replace the Dutch obligation when it applies.

“I have travel insurance.” Travel insurance is not Dutch basic insurance. For DAFT, travel insurance is usually a short bridge while you sort your Dutch admin and get insured correctly. It should not be your plan for living here.

“I’m not earning money yet, so I’m not really working.” DAFT is a self-employment residence route. Most DAFT entrepreneurs are living in the Netherlands and building their business from the start, even if revenue is not yet steady. Your obligation doesn’t wait for your first good month.

“Can a Dutch insurer deny my application?” If you are obliged to take out Dutch basic health insurance, insurers have an acceptance obligation for the basic policy. They may apply their own conditions to optional additional insurance. This matters if you are worried about pre-existing conditions or age.

Reference: SKGZ: Can a health insurer deny my application?

“My friend waited and nothing happened.” Enforcement can arrive with a delay. Government.nl and CAK both describe how uninsured people get letters, fines, and eventually enforced registration. The absence of a letter is not proof you are compliant. It is proof you have not been flagged yet.

Rule: Stop debating “coverage.” Confirm “obligation.” Then comply and keep proof.

Premiums, eigen risico, and the Zvw contribution (budgeting like a professional)

Most people only budget for the monthly premium. That’s incomplete. A clean DAFT setup treats healthcare costs like any other predictable system: premium plus known buffers plus taxes.

1) Premium (monthly payment to your insurer). Keep it on automatic payment. Don’t let it bounce.

2) Mandatory excess (eigen risico). The Dutch government sets the compulsory eigen risico each year. For 2026, the compulsory eigen risico is € 385. GP (huisarts) care is one of the key exceptions where no eigen risico applies, which matters for day-to-day decisions.

Official: Rijksoverheid: eigen risico (2026)

3) Income-dependent Zvw contribution (self-employed funding layer). Business.gov.nl explains that entrepreneurs and self-employed professionals also pay an income-dependent Zvw contribution on business profits. The percentage changes annually, and it sits on top of your monthly insurance premium. This is normal in the Dutch system. Budget for it so you never feel surprised later.

Official: Business.gov.nl: Income tax and healthcare insurance premium (Zvw)

Desk rule: In your monthly DAFT system, treat healthcare as three lines: premium, eigen risico buffer, and a tax set-aside that accounts for the Zvw contribution. Boring beats surprising.

Related: Paying Yourself on DAFT: Owner Draws, Tax Set-Asides, and a Monthly System

CAK letters, fines, and the enforcement sequence

This is where the “it’s probably fine” approach collapses. The Netherlands does not rely on motivation. It relies on enforcement.

CAK states that if you haven’t requested a Wlz assessment or taken out basic insurance within three months after receiving their uninsured letter, you will be fined. CAK also publishes the fine amount for 2026 and notes it is indexed annually. If you ignore the process long enough, CAK can ultimately take out health insurance on your behalf and you can receive multiple fines.

Official: CAK: I received a letter that I’m uninsured and CAK: I received a fine

DAFT warning: A CAK letter is not a discussion prompt. It is a timer.

I already bought insurance, why am I uninsured?

This happens, and it is usually boring. It is usually an admin mismatch, not a legal crisis.

CAK explains a specific failure mode: you may have taken out Dutch basic health insurance, but the insurance must be registered in the insured persons database (in Dutch: Referentiebestand Verzekerden Zorgverzekeringswet, RBVZ). If your insurer hasn’t registered you correctly, CAK still sees you as uninsured. The fix is to contact your insurer and make them correct the registration.

Official: CAK: RBVZ registration explanation

If you are on DAFT and you get a CAK letter even though you believe you are insured, run this desk process.

Check	What you are verifying	What to do if it’s wrong
Policy type	It is a Dutch basic policy (basisverzekering), not travel insurance or a private expat plan.	If it is not basic, take out Dutch basic insurance.
Start date	The effective date is clear on your confirmation.	Ask insurer what can be corrected and keep a written record.
BSN and address	Your insurer has your correct BSN and your correct registered address.	Update the insurer file immediately.
RBVZ registration	Your insurer registered you correctly in RBVZ.	Ask the insurer to fix RBVZ registration and confirm in writing.

Desk rule: If the system thinks you are uninsured, your job is to correct the system record. It is not to argue that you “feel insured.”

If you think you are exempt: SVB Wlz assessment

If you are in a real edge case, your goal is not to win a debate. Your goal is to get a formal decision. SVB provides an application process for an assessment of your Wlz insurance position, which is also the tool CAK points people to when they believe they are not obliged to have Dutch basic health insurance.

Official: SVB: Apply for an assessment of your Wlz insurance position and CAK: I don’t think I need Dutch health insurance

Practical advice: If you request a Wlz assessment, store the SVB decision in your “DAFT admin” folder and don’t lose it. This document ends arguments.

Kids and partners: what to do and what to keep

DAFT is often a family move. The rules are simple, but families still slip because nobody owns the task.

Children: children are not automatically insured. Newborns must be registered with a health insurer within 4 months after birth. If you insure them within that period, coverage starts from the day they were born. The same logic applies to older underaged children who are new to the Netherlands, if they are legally obliged to take out Dutch basic health insurance.

Reference: SKGZ: Children and registration timing

Government.nl also notes that children under 18 must have standard health insurance but do not pay premiums for the standard package. They still need to be registered correctly with an insurer.

Official: Government.nl: Standard health insurance (children)

Partners and spouses: treat each adult as their own compliance story. If they live or work in the Netherlands and the obligation applies, they need Dutch basic insurance. Don’t assume U.S. “family coverage” logic applies here.

Family admin rule: Put “health insurance compliance” on the same checklist as BRP registration. Assign a single owner and a date. Families drift when no one owns the task.

The desk checklist: a simple setup that stays boring

You don’t need to over-optimise in month one. You need to set the system up once, then stop thinking about it. Here is a simple checklist you can run.

Task	Target timing	What “done” looks like
Take out basic insurance	As soon as you can, well before month 4	You have a policy confirmation PDF with an effective start date and your correct personal details.
Set up payment	Immediately after the policy is issued	Premium is on direct debit or a reliable payment method. First payment clears.
Verify you are “in the system”	Within 2 weeks after the policy begins	If a CAK letter arrives, your insurer can confirm registration and correct mismatches quickly.
Create an “Insurance” folder	Same day you receive confirmation	Policy PDF, welcome letter, first payments, and any government letters are stored in one place.
Build healthcare buffers	First month budgeting	You have a premium line, an eigen risico buffer, and a tax set-aside that accounts for the Zvw contribution.
Register kids (if applicable)	As soon as you have your insurance set	Children are added and you have written confirmation from the insurer.

That is the whole game: a clean file, a boring budget, and a system that doesn’t rely on you remembering things. This is how you stay compliant without spending mental energy every month.

What documentation to keep

Most people don’t get fined because they refused to insure themselves. They get fined because their admin is messy, their address is wrong, or they cannot prove what they did and when they did it. Fix that with a small proof set that lives in one place.

Document	Why it matters
Policy confirmation (basisverzekering)	Proves you have Dutch basic insurance and shows the effective start date.
Welcome letter or membership confirmation	Useful for admin verification and future insurer communication.
First 2 to 3 premium payments	Proves the policy is active and paid. Helps if a system mismatch triggers a letter.
Any CAK letters and your responses	Shows you acted on time and followed the official process.
SVB Wlz assessment decision (if applicable)	Formal proof of your insurance position. This is what ends disputes.
Children added confirmation	Shows children are insured correctly and removes family-related surprises.

This is why we lightly connect insurance to bookkeeping. A renewal-ready DAFT file is not just invoices and KVK. It is a stack of boring proofs that show you are operating like a real resident and entrepreneur.

Related: DAFT Bookkeeping That Actually Works

Rule: If the system can fine you, keep proof that makes fines unlikely and responses easy.

Healthcare benefit (zorgtoeslag) and why DigiD matters

Once you have Dutch basic insurance, you may also be eligible for healthcare benefit (zorgtoeslag) depending on income and other factors. Government.nl describes healthcare benefit as a financial contribution towards the premium payable for your healthcare insurance and the compulsory excess.

Official: Government.nl: Applying for healthcare benefit

Operationally, the takeaway is simple: benefits are a digital workflow. The Tax Administration explains you apply online for benefits. If your BRP, BSN, and DigiD chain is blocked, you will feel blocked everywhere. Fix the admin chain early.

Official: Belastingdienst: I want to apply for a benefit

Don’t reverse engineer insurance for subsidies. Get compliant with the correct insurance first. Then check whether you qualify for healthcare benefit.

Related reading on Expat Advisory

If you want the broader DAFT compliance picture and a clean sequence for your first months, these are the next logical reads.

1) Your First 6 Months After DAFT: The Practical Setup That Keeps You Compliant
2) The DAFT 6-Month Window After Approval: What You Must Do and What You Must Actually Maintain
3) DAFT Bookkeeping That Actually Works

If you want a DIY workflow plus a second set of eyes to keep your documentation clean, the DAFT DIY Hub is built for exactly this kind of “boring compliance” planning.

Sources and official references

Use official sources as your source of truth. They update, they reflect legal obligations, and they explain enforcement in plain language.

• Government.nl: Coming to live or work in NL (4 months, foreign insurance, CAK warning)
• Government.nl: Compulsory standard health insurance
• Business.gov.nl: Compulsory healthcare insurance (entrepreneurs included)
• Business.gov.nl: Income-dependent Zvw contribution for entrepreneurs
• CAK: Received a letter that I’m uninsured (3 months, fine, RBVZ)
• CAK: I received a fine
• CAK: I don’t think I need Dutch health insurance (Wlz assessment path)
• SVB: Apply for a Wlz assessment
• SVB: Difference between Wlz and Zvw
• SVB: CAK letter context and basisverzekering obligation
• Rijksoverheid: eigen risico (2026)
• Government.nl: Standard health insurance (children)
• SKGZ: acceptance obligation and children registration
• Government.nl: Applying for healthcare benefit (zorgtoeslag)
• Belastingdienst: Applying for a benefit

If your facts are unusual (cross-border employment, international organisation arrangements, posted worker status), don’t guess. Use the SVB Wlz assessment route and keep the decision.